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<body lang=EN-US style='tab-interval:.5in'>

<div class=Section1 style="width: 670; height: 1029">
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        <td width="100%" height="1">
        <h6><font face="Times New Roman" size="3">CỘNG HOÀ XÃ HỘI CHỦ NGHĨA VIỆT NAM <o:p></o:p></font></h6>          
        <p class=MsoNormal align=center style='text-align:center;word-spacing:0in'><span
  style='mso-font-kerning: 14.0pt'><font size="3" face="Times New Roman"><b>Độc lập-Tự          
        do -Hạnh phúc</b><u1:p> </font></span></p>
        <p class=MsoNormal align=center style='text-align:center;word-spacing:0in'><span
style='font-size:10.0pt;font-family:Arial;mso-font-kerning:14.0pt'>***************</span></p>
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      </tr>
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  <p class=MsoNormal align=center style='text-align:center;word-spacing:0in'><span
style='font-size:10.0pt;font-family:Arial;mso-font-kerning:14.0pt'><o:p></o:p></span><font face="Times New Roman"><span         
style='mso-font-kerning:14.0pt'><o:p></o:p></span></font></p>
<div align="center">
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      <tr>
        <td><h1 align=center style='text-align:center;mso-list:none;tab-stops:.5in'><font size="4" face="Times New Roman">ĐƠN XIN C&#7844;P LẠI, CẤP ĐỔI, XÁC NHẬN THAY ĐỔI</font></h1>
        <h1 align=center style='text-align:center;mso-list:none;tab-stops:.5in'><font size="4" face="Times New Roman">GIẤY CH&#7912;NG NHẬN QSH NH&Agrave; &#7902;</font><font face="Times New Roman"><span         
style='mso-font-kerning:14.0pt'><o:p></o:p></span></font></h1></td>
      </tr>
      <tr>
        <td><div align="center"><font size="4" face="Times New Roman">Kính gửi: Phòng H&#7841; Tầng Kinh T&#7871; TP Vũng Tàu </font></div></td>
      </tr>
      <tr>
        <td>&nbsp;</td>
      </tr>
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  </div>
  <p align="center"><font size="4" face="Times New Roman"></font></p>
  <div align="center"><font size="4" face="Times New Roman">&nbsp;</font>    
    
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          <td colspan="2"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Tên tôi là: #2#</span></font></span></td>
          <td width="237"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Chứng minh nhân dân:&nbsp; #3#</span></font></span></td>
          <td colspan="2"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Ngày cấp: #4#</span></font></span></td>
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          <td colspan="3"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Nơi đăng ký hộ khẩu thường trú: #6#</span></font></span><span class="MsoNormal"><font face="Times New Roman" size="4"></font></span></td>
          <td colspan="2"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Điện thoại :&nbsp; #7#</span></font></span></td>
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          <td colspan="2">&nbsp;</td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
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          <td colspan="5"><div align="center"><b><font size="4" face="Times New Roman">Xin #1# giấy chứng nhận QSH nh&agrave; &#7903; cho c&aacute;c ch&#7911; sở hữu d&#432;ới &#273;&acirc;y</font></b></div></td>
        </tr>
        <tr>
          <td colspan="2">&nbsp;</td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
        </tr>
        <tr>
          <td width="197"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">&Ocirc;ng :&nbsp;</span></font><font face="Times New Roman" size="4"><b><span style='mso-bidi-font-size: 10.0pt'>#8#</span></b><o:p></o:p></font></span></td>
          <td width="189"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style='mso-bidi-font-size: 10.0pt'>B&agrave; : #9#.</span></font></span></td>
          <td><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">&#272;ịa ch&#7881; nh&agrave; &#7903; : #10#</span></font></span></td>
          <td colspan="2"><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Thuộc x&atilde; : #11#</span></font></span></td>
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          <td><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Diện t&iacute;ch s&agrave;n : #12# m2 </span></font></span></td>
          <td><span class="MsoNormal"><font face="Times New Roman" size="4"><span style="mso-bidi-font-size: 10.0pt">Số tầng : #13#</span></font></span></td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
        </tr>
        <tr>
          <td colspan="2"><span class="MsoNormal"><font size="4" face="Times New Roman">Kết cấu nh&agrave; : #14#</font></span></td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
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        <tr>
          <td colspan="2"><span class="MsoNormal"><strong>*C&#7845;p, hạng nh&agrave; &#7903;</strong></span></td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
        </tr>
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          <td colspan="2"><span class="MsoNormal"><font size="4" face="Times New Roman">Di&#7879;n t&iacute;ch s&agrave;n nh&agrave; ph&#7909;(nếu c&oacute;): #15# m2 </font></span></td>
          <td><span class="MsoNormal"><font size="4" face="Times New Roman">Giấy chứng nhận QS&#272; s&#7889;:#16#</font></span></td>
          <td colspan="2"><span class="MsoNormal"><font size="4" face="Times New Roman">Ngày : #17# </font></span></td>
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          <td colspan="2"><span class="MsoNormal"><font size="4" face="Times New Roman">Di&#7879;n tích &#273;ất &#7903; :#18# m2 </font></span></td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
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          <td><span class="MsoNormal"><font size="4" face="Times New Roman">S&#7917; dụng ri&ecirc;ng :#19# m2</font></span></td>
          <td><span class="MsoNormal"><font size="4" face="Times New Roman">S&#7917; dụng chung : #20# m2</font></span></td>
          <td>&nbsp;</td>
          <td colspan="2">&nbsp;</td>
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          <td><span class="MsoNormal"><font size="4" face="Times New Roman">Th&#7917;a &#273;ất s&#7889; :#21# </font></span></td>
          <td><span class="MsoNormal"><font size="4" face="Times New Roman">T&#7901; bản đồ s&#7889; :#22#</font></span></td>
          <td>&nbsp;</td>
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          <td><span class="MsoNormal"><strong>&#272;ất &#273;&#432;&#7907;c giao : #23# </strong></span></td>
          <td><span class="MsoNormal"><strong>&#272;ất thu&ecirc;: #24# </strong></span></td>
          <td><span class="MsoNormal"><strong>H&#7907;p &#273;&#7891;ng thu&ecirc; &#273;&#7845;t s&#7889; :#25# </strong></span></td>
          <td width="193"><span class="MsoNormal"><strong>Thời gian thu&ecirc; t&#7915;:#26#</strong></span></td>
        <td width="105"><span class="MsoNormal"><strong>&#272;&#7871;n:#27#</strong></span></td>
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        <td width="53%"><b><i><font face="Times New Roman" size="3">Kèm theo đơn:<o:p>  
          </font><font face="Times New Roman" size="4"> 
          </o:p>
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        <p><font face="Times New Roman" size="3"><i>#INCLUDE_DOCUMENT#</i></font></td>
        <td width="47%"><p align="center"><i><font face="Times New Roman" size="3"><em> Vũng Tàu</em>, #RECEIVE_DATE#</font></i>
          <p align="center"><b><font face="Times New Roman" size="3">Ng&#432;ời l&agrave;m &#273;&#417;n</font></b>
          <p align="center"><i><font face="Times New Roman" size="3">(Ký ghi rõ họ tên)</font></i></td>
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